Civilian casualties of Iraqi ballistic missile attack to Tehran, capital of Iran / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To determine the pattern of causalities of Iraqi ballistic missile attacks on Tehran, the capital of Iran, during Iraq-Iran war.</p><p><b>METHODS</b>Data were extracted from the Army Staff Headquarters based on daily reports of Iranian army units during the war.</p><p><b>RESULTS</b>During 52 days, Tehran was stroked by 118 Al-Hussein missiles (a modified version of Scud missile). Eighty-six missiles landed in populated areas. During Iraqi missile attacks, 422 civilians died and 1 579 injured (4.9 deaths and 18.3 injuries per missile). During 52 days, 8.1 of the civilians died and 30.4 injured daily. Of the cases that died, 101 persons (24%) were excluded due to the lack of information. Among the remainders, 179 (55.8%) were male and 142 (44.2%) were female. The mean age of the victims was 25.3 years+/-19.9 years. Our results show that the high accuracy of modified Scud missiles landed in crowded areas is the major cause of high mortality in Tehran. The presence of suitable warning system and shelters could reduce civilian casualties.</p><p><b>CONCLUSION</b>The awareness and readiness of civilian defense forces, rescue services and all medical facilities for dealing with mass casualties caused by ballistic missile attacks are necessary.</p>

Trauma care system in Iran / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to describe the current status of trauma system regarding the components and function.</p><p><b>METHODS</b>The current status of trauma system in all components of a trauma system was described through expert panels and semi-structured interviews with trauma specialists and policy makers.</p><p><b>RESULTS</b>Currently, various organizations are involved in prevention, management and rehabilitation of injuries, but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of public education through media, traffic regulation reinforcement, hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training standards of the front line medical team and continuing education and evaluation are yet to be addressed. Trauma registry has been piloted in some provinces, but as it needs the well-developed infrastructure (regarding staff, maintenance, financial resources), it is not yet established in our system of trauma care.</p><p><b>CONCLUSIONS</b>It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system.</p>

Pattern of animal-related injuries in Iran

Animal related injuries as most common causes of human morbidity have different pattern by geographical zones. We aimed to explore the main descriptive epidemiology of animal-related injuries in both rural and urban areas in Iran. Between 2000 and 2004, we collected the data of all the cases of animal related trauma hospitalized for more than 24 hours in eight cities [Tehran, Mashhad, Ahwaz, Shiraz, Tabriz, Qom, Kermanshah, and Babol]. Further evaluations were conducted on 17753 eligible subjects. Of 17753 traumatic patients, 40 subjects [0.2%], had animal-related injuries. The highest rate was seen in Tabriz with 11 cases. Upper and lower extremities were the most frequent sites of trauma and they were injured in 13 and 11 cases respectively. Dog bite and cow-related injuries were responsible for 40% and 32.5% of injuries respectively. Amputation of the phalanx was done in 2 cases due to dog bite and bull gore occurred. One thoracotomy, one laparatomy and one craniotomy were done. One patient needed fasciatomy due to snake bite. Educating the patients could decrease the incidence of morbidity of these injuries

Civilian casualties of Iranian cities by ballistic missile attacks during the Iraq-Iran war (1980-1988) / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To determine the nature and extent of Iranian casualties by ballistic missile attacks during the eight years of the Iraq-Iran war.</p><p><b>METHODS</b>The data collected about Iraqi missile strikes on Iranian cities included the following: date and time, number and type of missiles, cities targeted, and injuries and deaths resulting from impacts of missiles in civilian areas. The data were extracted from a database that was constructed by the army staff headquarters based on daily reports of Iranian army units during the war.</p><p><b>RESULTS</b>Over a period of eight years (1980-1988), Iraqi army fired 533 ballistic missiles at Iranian territories. From those, 414 missiles (77.7%) landed on Iranian cities. The impacts of these missiles caused the deaths of 2,312 civilians and injured 11,625 others. Three types of ballistic missiles were used: FROG-7, Scud, and Al-Hussein (a modified version of the Scud missile). Twenty-seven cities in Iran were struck by Iraqi ballistic missiles. The highest mortalities from ballistic missiles were in Dezful and Tehran. Iraqi missile attacks continued for 90 months (2,748 days).</p><p><b>CONCLUSION</b>Our results point to the necessity of investigating the psychological consequences of Iraqi ballistic missile attacks among survivors in 27 Iranian cities during the eight years of the Iraq-Iran war.</p>

Extremity fractures in children: a hospital based study in Tehran / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Although long bone fracture in children is not life-threatening, it may cause major disability, loss of working days and severe psychological distress. We conducted this study to determine the pattern of extremity fracture due to trauma in children.</p><p><b>METHODS</b>During one year in six general hospitals in Tehran, trauma patients who were hospitalized for more than 24 hours and sustained injuries within seven days before admission were included in the study. The records of children (< or = 16 years old) hospitalized in six general hospitals in Tehran due to trauma were reviewed prospectively.</p><p><b>RESULTS</b>During the study period, 1 274 children had sustained extremity fractures. Male to female ratio was 3.6/1, with the mean age of (10.3+/-4.2) years. Falls and traffic crashes were the main causes of injuries, with the percentages of 57.3% and 37.1%, respectively. Simple fall (falling on the ground) consisted 60% of patients that sustained fall-related injuries. Pedestrians and bicycle riders comprised most of the cases that were injured due to traffic crashes. Of our cases, 56.8% sustained fractures in the upper extremities and 43.2% in the lower extremities. Forearm was the most common fracture site (34.1%). Comparing our results in preschool and school-age children, falls were the main cause of injuries in both groups, but fractures of lower extremities were significantly more common in preschool children.</p><p><b>CONCLUSIONS</b>Improvement of physical condition of sidewalks and crossings in roads will be necessary for prevention of injuries. More attention to safety of home environment should be paid for control of preschools'injury at home. Education of children and adults is necessary to reduce injuries resulting from road traffic crashes.</p>

Seat belt use during pregnancy in Iran: attitudes and practices / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Seat belt use during pregnancy reduces injury to the mother and her fetus. During recent years, the use of seat belts has been mandated by law in Iran. The purpose of this study was to determine the attitudes and practices of pregnant women regarding seat belt use.</p><p><b>METHODS</b>In this cross-sectional study, we asked 335 pregnant women at a hospital-based prenatal care clinic on the use of safety belt before and during pregnancy. SPSS version 13.0 was used for data analysis.</p><p><b>RESULTS</b>The mean age of study subjects was 27.3 years ± 5.3 years with the median of 27 years. Compared with the seat belt use before pregnancy, no change was detected in 48.7% of the women; seat belt use had increased in 17.5 % of them and decreased in 33.8 %. Eighty-one percent of women knew the correct placing of both lap belt and shoulder belt. Only 4% of women had received education on proper restraint use during pregnancy.</p><p><b>CONCLUSIONS</b>The prevalence of seat belt use during pregnancy is lower than reports which are mostly from developed nations. The fact that about one-third of women have decreased their seat belt usage during pregnancy highlights the importance of education of mothers on this topic.</p>

Mortality of the Iranian ex-prisoners of war in Iraqi detention camps [1980 -1990]

The present study aimed to determine the rate and cause of the mortality of the Iranian ex-prisoners of war in Iraqi detention camps during a ten- year period [1980 _ 1990] according to the documented reports. The information extracted from the documented death certifications that have been provided by the Iraqi authorities and the Red Cross delegation. At least a total of 564 Iranian prisoners of war died due to the various reasons in Iraqi detention camps that show a mortality rate of 1.4% [564/40,000]. The mean captivity-to-death interval was 440 [from one to 3582] days and the registered prisoners had more duration of captivity than the unregistered [1285 vs. 215 days, P= 0.001]. The median and mean ages of the individuals at the time of death were 22 and 26.4+13 years, respectively. The mean age of the civilians was higher than the others [45.3 vs. 23.7, P=0.0001]. The cause of death was not clear for 44.3% of the individuals but among the others, infectious diseases [such as dysentery, sepsis, and meningitis] and injuries [resulting from war injuries and/or torture by Iraqi forces] were the main causes of death with 15.4% and 15.6%, respectively. It seems that the mortality of the Iranian ex-prisoners of war in Iraq is more than previously reported. Therefore, more investigation is recommended to determine the exact number of the Iranian prisoners who died in Iraq

Analysis of 274 patients with extremity injuries caused by the Bam earthquake / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>The extremity injury pattern after a major earthquake is not well understood because data on this type of injury and management are limited. The aim of this study was to analyze the data of trauma patients with extremity injury in the earthquake of Bam Iran, registering 6.6 on the Richter scale.</p><p><b>METHODS</b>We reviewed medical records of 486 patients admitted to hospitals of Tehran University of Medical Sciences. Among them, 274 patients sustained extremity injuries. This group was composed of 138 females (50.4%) and 136 males (49.6%) and 213 cases (77.7%) were under 40 years of age.</p><p><b>RESULTS</b>Fracture was the major type of injury (58.4% of extremity injuries). The most common sites of injury were lower extremities (185 patients, 67.5% of all victims). Pelvic and rib fractures and abdominal injuries were the most frequently associated injuries. The mean ISS was 6.2+/-4.0, and 61% of the patients had ISS less than 7. Amputation and death occurred in 2.9% and 2.5% of cases, respectively.</p><p><b>CONCLUSIONS</b>Special attention should be given to dealing with orthopedic injuries in similar disasters in the future.</p>

Patterns of extremity traumas leading to amputation in Iran: results of Iranian National Trauma Project / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To determine the patterns of traumatic extremity injuries leading to amputation in Iran.</p><p><b>METHODS</b>Data of Iranian National Trauma Project was used to identify patients with upper and lower extremity traumas undergoing amputation. This project was conducted in 8 major cities during 2000-2004.</p><p><b>RESULTS</b>Of 17 753 traumatic patients, 164 (0.92%) had injuries to the extremities that resulted in the limb amputation. Of these, 143 (87.2%) were men. The patient's mean age was 29.0 years +/- 15.4 years and the highest incidence was seen in the age group of 21 to 30 years (34.1%). One hundred and four cases were occupational accidents (63.4%). Blunt trauma was in 54.9% of the cases. The most common reasons for amputation were respectively stabbings (37.8%) and crush injuries (31.7%). Amputation of hand fingers was the most frequent type of amputation (125 cases, 76.2 %). One patient died from severe associated injuries.</p><p><b>CONCLUSIONS</b>This study shows the patterns of traumatic limb amputation in Iran, a developing country. Results of this study may be used in preventive strategic planning.</p>

Hospital management of abdominal trauma in Tehran, Iran: a review of 228 patients / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Today, trauma is a major public health problem in some countries. Abdominal trauma is the source of significant mortality and morbidity with both blunt and penetrating injuries. We performed an epidemiological study of abdominal trauma (AT) in Tehran, Iran. We used all our sources to describe the epidemiology and outcome of patients with AT.</p><p><b>METHODS</b>This study was done in Tehran. The study population included trauma patients admitted to the emergency department of six general hospitals in Tehran during one year. The data were collected through a questionnaire that was completed by a trained physician at the trauma center. The statistical analysis was performed using the SPSS software (version 11.5 for Windows). The statistical analysis was conducted using the chi-square and P < 0.05 was accepted as being statistically significant.</p><p><b>RESULTS</b>Two hundred and twenty-eight (2.8%) out of 8,000 patients were referred to the above mentioned centers with abdominal trauma. One hundred and twenty-five (54.9%) of the patients were in their 2nd and 3rd decades of life and 189 (83%) of our patients were male. Road traffic accidents (RTA) were the leading cause of AT with 119 (52.2%) patients. Spleen was the commonly injured organ with 51 cases. Following the analysis of injury severity, 159 (69.7%) patients had mild injuries (ISS < 16) and 69 (30.3%) patients had severe injuries (ISS equal to 16). The overall mortality rate was 46 (20.2%).</p><p><b>CONCLUSIONS</b>Blunt abdominal trauma is more common than penetrating abdominal trauma. Road traffic accidents and stab wound are the most common causes of blunt and penetrating trauma, respectively. Spleen is the most commonly injured organ in these patients. The mortality rate is higher in blunt trauma than penetrating one.</p>

Pattern of injury in Shiraz / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Injury is a major neglected health problem in developing countries. The first step in dealing with injury problem is to identify the injury patterns and characteristics. Therefore, we aimed to demonstrate the current status of trauma admissions to hospitals in Shiraz, as a major city of Iran.</p><p><b>METHODS</b>A hospital-based study was conducted in 2002. All injured patients admitted during 6 months in emergency departments of two general hospitals of Shiraz, Nemazi and Chamran were included.</p><p><b>RESULTS</b>A total of 1,765 injured patients were registered during the study period, with mean age of 33 years. Manual workers were the most vulnerable group among occupational categories. Inner-city roads were the most common place of injury and traffic accident was the major cause of injury. Overally, falling injury was the second common cause of injury in males and the first cause in females (especially at the age of over 60).</p><p><b>CONCLUSION</b>As other studies conducted in our society, traffic accidents are the major cause of morbidity and mortality and this can emphasize on the obligation to take legislative action in the field of driving and road safety, directing resources and educating the public and raising the awareness of the community in prevention of this iceberg-like problem.</p>

Thoracic injury: a review of 276 cases / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Chest injury, one of the most important aspects of trauma, directly accounts for 25% of all trauma-related deaths and plays a major contributing role in another 25% of trauma deaths. This paper aimed to explore the spectrum and outcome of thoracic injuries seen in a multi centric study of trauma patients.</p><p><b>METHODS</b>A total of 276 consecutive trauma patients in 6 general hospitals were analyzed. The feature of injury, injury severity score (ISS), clinical treatment and mortality were recorded in a prospective manner and analyzed retrospectively. Multiple logistic regression analysis was used to determine the independent predictors of mortality following the chest trauma.</p><p><b>RESULTS</b>There were 246 males (89.1%) and 30 females (10.9%) ranging from 3 to 80 years with a mean age of (34+/-17) years. Road traffic accident was the main cause of injury, especially for pedestrians, followed by stab wound (89 cases, 32.1%) and falling injuries (32 cases, 11.6%), respectively. Haemothorax or pneumothorax (50.4%) and rib fracture (38.6%) were the most common types of chest injury. Extremity fracture was the most common associated injury with the rate of 37% ( 85/230), followed by head injury (25.2%) and abdominal trauma (19.6%). These injuries contributed significantly to the morbidity and mortality of trauma patients.</p><p><b>CONCLUSIONS</b>According to the results, most patients with chest injury can be treated conservatively with close observation and tube thoracostomy. The presence of blunt trauma, head injury and abdominal injury independently adversely affect mortality after chest trauma. It is necessary to investigate the causes and patterns of injuries resulting from stab wound for effective prevention.</p>

Chest injury in victims of Bam earthquake / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To analyze the data of trauma patients with thoracic injury in the earthquake of Bam admitted to hospitals of Tehran University of Medical Science (TUMS) for better understanding the type and consequence of thoracic injuries in a major earthquake.</p><p><b>METHODS</b>After Bam earthquake registering 6.5 on the Richter scale, 526 trauma patients were admitted to hospitals of TUMS. Among them, 53 patients sustained thoracic injury.</p><p><b>RESULTS</b>This group was composed of 21 females (39.6%) and 32 males (60.4%). Fifteen patients (28.3%) had isolated chest injuries. Rib fracture (36.4%) was the most common injury in our patients and haemo/pneumothorax (25.5%) followed. Superficial injury was the most common accompanying injury. Multiple-trauma patients with chest injury had higher injury severity score (ISS) versus patients with isolated chest injury (P=0.003).</p><p><b>CONCLUSIONS</b>Chest wall injuries and haemo/pneumothorax comprise a considerable number of injuries in survival victims of earthquakes. Consequently, the majority of these patients can be treated with observation or tube thoracostomy. We should train and equip the health workers and members of rescue teams to treat and manage these patients in the field.</p>

Epidemiology of urogenital trauma in Iran results of the Iranin national trauma project

We report the incidence, distribution, etiology, and outcome of the urogenital trauma in 8 major cities of Iran according to the database of national trauma project. Between 2000 and 2004, we prospectively collected the data of all the traumatic patients hospitalized for more than 24 hours in 8 cities [Tehran, Mashad, Ahwaz, Shiraz, Tabriz, Qom, Kermanshah, and Babol]. We analysed the data taken from 17 753 trauma admissions. Patients with sustained urogenital traumas were identified and studied. A total of 175 patients [0.98%] had injuries to the urogenital system. Male to female ratio was 4. The patients' mean age was 25 +/- 16 years [range, 2 to 80 years]. Of 175 patients, 159 [90.9%] had blunt trauma and 16 [9.1%] had penetrating trauma. Road traffic accident was the most common cause of trauma [65.1%]. The most common injured organs were the kidney in 61.1% and the bladder in 13.7%. One hundred and forty-two patients [81.1%] had associated intra-abdominal injuries and 129 [73.7%] had other accompanying injuries. Sixty [34.2%] patients required surgical intervention. Nine patients [5.2%] died due to the severity of the injuries. All patients who died had severe injuries [Injury Severity Score >12]. In Iran, blunt traumas including road traffic accidents are the main cause of urogenital traumas. The majority of the patients with urogenital trauma have multiple injuries and require a multidisciplinary approach

An epidemiological study of work-related mortality referred to Tehran Legal Medicine Organization [2002-2003]

Trauma is the leading cause of death in patients has 3-44 of years olds. According to the report of the International Labor Organization [ILO], LI million work-related deaths occur every year. Severity and prevalence of work related hazards are more obvious in developing countries. We conducted the study for better understanding of work-related mortality in Tehran. During one year of study, 184 deaths due to work-related injuries reported to Tehran Legal Medicine Organization [TLMO], the only center for referral of trauma deaths in Tehran. All of victims were males. Construction workers account for 38% of all reported deaths. The most common cause of injury was falling down [31%], Impact of Blunt object and burn with 27.2% and 13.6%, respectively. Head injury was the main cause of death with 28/8% and multiple injuries consisted second cause with 19% prevalency. According to the results of this study Construction and industrial worker are the main group of preventional policy from work related injury. A majority of work related injury and mortality are preventable. So prevention program like usage of physical protective equipment, educational program for safety training, supervision over workplace could be effective to reduce work related mortality and morbidity

use of head CT scanning in mild head injury

To determine the number of brain CT scans carried out in patients with mild head injury [MHI] during 13 months of trauma registry, and to investigate means of reducing the rate of unnecessary scans. During a trauma registry [from August 23, 1999 to September 21, 2000] in 6 general Hospitals [Imam Hussein, Moayer, Sina, Hafteteer, Imam Khomeini and Shariatti] in Tehran, Iran, 1209 cases with Glasgow Coma Scale [GCS] score >13 underwent brain CT scan. To be included in the study, patients must have sustained their injury within one week prior to presentation to Emergency Rooms, and were hospitalized for more than 24 hours. The attending physicians formally reported all brain CT scan findings. For 1209 patients, there were the following characteristics: mean age was 29.4 years; the main cause of injury was traffic accidents [60.1%], followed by falls [28.5%], fights [7.2%], and other reasons [4.2%]. Seventy-seven cases [6.4%] had a GCS score of 13, 212 [17.5%] had a score of 14, and 920 [76%] had a score of 15. A total of 481 abnormalities on CT scan were reported for 405 patients [33.5%] with positive report of brain CT scan, while 804 cases [66.5%] did not report abnormalities. The most common intracranial lesion was epidural hemorrhage with 146 cases [30.3%]. The rate of negative reporting of brain CT scan in patients who had GCS score of 15 was 72.2%. Patients who have GCS score of 13 or 14 on admission should be considered to have a moderate rather than a mild head injury. For reduction of unnecessary brain CT scan performance in MHI patients, we must define the appropriate criteria